Notice bibliographique
Résumé
A 65-year-old woman was admitted to hospital with osteomyelitis of her left fourth toe requiring intravenous antibiotic therapy. Her medical history included type 2 diabetes mellitus, chronic renal failure requiring hemodialysis and mitral stenosis. During the second week in hospital the patient was evaluated for a 1-day history of mild, generalized non-colicky abdominal discomfort. She had nausea but no vomiting and remained afebrile. The patient was obese, and the examination was notable only for diffuse distension. Liver enzyme levels and serum amylase and lipase levels were all within normal limits. Radiography of the abdomen revealed an ileus as well as a large calcified spherical mass in the right upper quadrant (Fig. 1A). A non-contrast CT scan was obtained, which revealed the mass to be a large calcified gallbladder (Fig. 1B). Figure F1A. Photo by: Courtesy Lucie Opatrny Figure F1B. Photo by: Courtesy Lucie Opatrny After completion of the antibiotic therapy, prophylactic cholecystectomy was performed because of the reported association between porcelain gallbladder and cancer of the gallbladder. Pathology results revealed cholelithiasis and cholecystitis in addition to calcification of the gallbladder wall. There was no evidence of malignant disease. The patient was discharged after an uneventful postoperative course. The term “porcelain gallbladder” was coined in 1929 to describe the bluish discoloration and brittle consistency of a gallbladder with an extensively calcified wall.1 Intramural gallbladder calcification is rare, with a reported incidence of 0.06%–0.8% of cholecystectomy specimens.2,3 The cause remains unknown, but the vast majority of specimens have concurrent cholelithiasis, leading some authors to suggest that porcelain gallbladder is an unusual manifestation of chronic cholecystitis.2 It is most commonly found in the sixth decade of life, with a female:male ratio of 5:1. The incidence of cancer arising in porcelain gallbladders is widely quoted as varying from 12% to 62%.4,5 These rates were based on retrospective studies and case series published in the 1950s and 1960s. However, recent reviews suggest that the association between porcelain gallbladder and cancer is less than previously suggested. A review of 10 741 records of cholecystectomies revealed 88 reports of cancerous gallbladders (none of which showed calcification) and 15 of calcified gallbladders (none of which was associated with cancer).3 Similarly, a review of about 25 900 cholecystectomy records identified 150 cases of gallbladder cancer and 44 of calcified gallbladder, with about 7% of the calcified specimens showing signs of cancer.6 Given the poor prognosis of gallbladder cancer, current guidelines continue to recommend prophylactic cholecystectomy in cases of porcelain gallbladder.7 Lucie Opatrny Resident in Internal Medicine Royal Victoria Hospital Montreal, Que.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».